Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Langenbecks Arch Surg. 2022 Aug;407(5):1949-1959. doi: 10.1007/s00423-022-02440-9. Epub 2022 Mar 20.
Postpancreatectomy hemorrhage grade C (PPH C) is a dreaded complication after pancreaticoduodenectomy (PD) with high mortality rate. Concurrent risk factors for PPH C have been difficult to recognize. Connection between postoperative pancreatic fistulas (POPF) and PPH C is well known, but POPF is often unknown prior to the PPH. The aim of this retrospective study was to define potential predictive factors for PPH C.
Retrospectively, 517 patients who underwent PD between 2003 and 2018 were included in the study. Twenty-three patients with PPH C were identified, and a matched control group of 92 patients was randomly selected. Preoperative data (body mass index, cardiovascular disease, history of abdominal surgery, biliary stent, C-reactive protein (CRP), ASA-score), perioperative data (bleeding, pancreatic anastomosis, operation time), and postoperative data (CRP, drain amylase, POPF, biliary fistula) were analyzed as potential predictors of PPH C.
High postoperative CRP (median 140 mg/L on day 5 or 6) correlated with the development of PPH C (p < 0.05). Postoperative drain amylase levels were not clinically relevant for occurrence of PPH C. Grade C POPF or biliary leak was observed in the majority of the PPH C patients, but the leaking anastomoses were not detected before the bleeding started.
High postoperative CRP levels are related to an increased risk of PPH C.
胰十二指肠切除术后（PD）发生 C 级胰瘘出血（PPH C）是一种死亡率较高的严重并发症。同时存在的多种危险因素使 PPH C 难以识别。术后胰瘘（POPF）与 PPH C 之间的关系是明确的，但 PPH C 发生前 POPF 通常并不明确。本回顾性研究旨在确定 PPH C 的潜在预测因素。
回顾性纳入 2003 年至 2018 年间接受 PD 治疗的 517 例患者。确定了 23 例 PPH C 患者，并随机选择了 92 例匹配的对照组患者。分析了术前数据（体重指数、心血管疾病、腹部手术史、胆道支架、C 反应蛋白（CRP）、ASA 评分）、围手术期数据（出血、胰腺吻合、手术时间）和术后数据（CRP、引流淀粉酶、POPF、胆瘘），以评估其对 PPH C 的潜在预测作用。
术后 CRP 水平较高（第 5 或 6 天的中位数为 140mg/L）与 PPH C 的发生相关（p<0.05）。术后引流淀粉酶水平对 PPH C 的发生无明显临床意义。大多数 PPH C 患者发生了 C 级 POPF 或胆漏，但在出血开始前并未发现漏口吻合。
术后 CRP 水平升高与 PPH C 风险增加有关。
